Axillary vein access for permanent pacemaker and implantable cardioverter defibrillator implantation: Fluoroscopy compared to ultrasound.

Abstract

Axillary vein access (AVA) using fluoroscopic landmarks is an effective and safe approach for cardiac implantable electronic devices (CIEDs) implantation. However, it may result in a higher radiation exposure. Ultrasound-guided axillary access (USAA) is an effective alternative technique to conventional subclavian access for CIEDs implantation. Studies comparing USAA and AVA using fluoroscopic landmarks are lacking. The purpose of this study was to compare the safety, efficacy, and radiation exposure data of the USAA approach with the AVA using fluoroscopic landmarks. The study population included 95 consecutive patients (61% male, median age 78 years [71-85 years]) referred for CIEDs implantation using AVA with fluoroscopic landmark (n=46) or USAA (n=49). Baseline characteristics and radiation exposure data (Air-Kerma [mGy], DAP [Gy-cm2 ], fluoroscopy time [seconds], and X-rays emission time [seconds]) were compared according to the technique used for the AVA. Axillary vein was successfully accessed in 45 of 49 (92%) patients using ultrasound and in 42 of 46 (91%) patients using fluoroscopic landmarks (P=1.00). Air-Kerma, DAP, fluoroscopy time, and X-rays emission time were shorter for USAA group compared with AVA using fluoroscopic landmarks (11 mGy [8-20] vs 37 mGy [24-81], P<.00001; 3Gy-cm2 [2-5] vs 10Gy-cm2 [6-16], P<.00001; 97seconds [62-163] vs 271seconds [185-365], P<.00001; and 7 seconds [4-10] vs 21seconds [13-39], P<.00001). There were no significant differences between the two groups in median implant procedure time (P=.55). We did not encounter any acute or long-term complications in both groups. Ultrasound-guided axillary vein cannulation for CIEDs implantation is a feasible and safe alternative approach and offers a significant reduction in fluoroscopy times without increasing procedural time.